An Additional Therapy for Post-Traumatic Stress Disorder

It is estimated that 13-20 percent of U.S. troops returning from Iraq and Afghanistan and about 30 percent of Vietnam-era veterans suffer from post-traumatic stress disorder (PTSD). However, PTSD is difficult to treat. Currently available treatments include SSRI antidepressant medications and certain psychotherapies.

Preliminary studies indicate that treatments with different underlying mechanisms may also be helpful. For example, there is some evidence that MDMA (ecstasy)-assisted psychotherapy may be effective in reducing PTSD symptoms. Phase 3 studies are being launched to test MDMA in a large number of individuals. Another approach takes advantage of the fact that memories, when recalled, can be modified and then reconsolidated. Using this technique, a person recalls uncomfortable memories and is then given a drug that interferes with the reconsolidation of such memories. Currently available drugs like propranolol, a commonly used antihypertensive medication that can interfere with memory reconsolidation if administered at a specific time during memory recall, can be used for this purpose.

Jill Bormann and colleagues are studying a different approach to the treatment of PTSD—mantram repetition therapy. These investigators previously demonstrated that, when administered in a group setting, this therapy reduced PTSD symptom severity, improved sleep, and increased individuals’ ability to manage their PTSD symptoms. In a more recent study published in the American Journal of Psychiatry, the Bormann group compared individually delivered mantram repetition therapy to present-centered psychotherapy, a treatment that has been shown to alleviate some symptoms of PTSD.

What is mantram repetition therapy? It is a type of mindfulness therapy based on the idea that silently repeating a “mantram” (a spiritually based word or phrase) helps a person focus attention, relax, and become more present in the moment. In the mantram repetition program, Bormann’s group teaches mantram repetition along with two other techniques: “slowing down” and “one-pointed attention.” (One-pointed attention is the ability to concentrate on one task at a time.) Taken together, these techniques teach individuals how to focus their thoughts in the present moment.

Present-centered therapy is a supportive, problem-solving psychotherapy. Like mantram repetition therapy, it does not involve recalling trauma-related memories. It has been shown to be more effective than a waiting list condition in treating symptoms of PTSD. In some studies, it has been used as a so-called “active control” in trials of therapies for PTSD.

The Bormann et al. study involved 173 veterans at two Veterans Affairs (VA) outpatient clinics who had been diagnosed with military-related PTSD. Standardized assessments were used to exclude individuals with other severe psychiatric disorders. Symptoms of PTSD were assessed with the Clinician-Administered PTSD Scale as well as a self-reported PTSD checklist. Participants were randomized to one of two groups: one received mantram repetition therapy and the other received present-centered therapy. Both groups met with therapists individually for eight 1-hour weekly sessions.

The individuals who received mantram repetition therapy had a greater decrease in PTSD symptoms at the end of the eight weeks of treatment than those who received present-centered psychotherapy. They also experienced better sleep outcomes. The results of this study suggest that relatively simple mindfulness techniques may lessen the symptoms of PTSD.

It should be noted that more than half the study participants were taking medications for PTSD when they were enrolled into the study. These participants had been on a stable dosage for at least the previous six weeks and were instructed to continue taking their medications as prescribed. There was no difference between the two study groups in medication use. The investigators asked all participants to refrain from participating in other forms of psychotherapy during the course of the study.

More research is necessary to establish the efficacy of newer treatments for PTSD. It is possible that a combination of pharmacologic (SSRIs) and non-pharmacologic (mantram repetition, cognitive behavioral therapy, present-centered therapy) approaches may be helpful in treating this serious disorder. Symptom remission may be an achievable goal.

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.

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